An app a day

29 October 2018

Non-adherence to treatment regimens costs healthcare systems hundreds of billions of dollars every year. Elly Earls speaks to Jon Lee-Davey, internet of things (IoT) health lead at Vodafone, to discuss how an IoT-powered solution could potentially save money and lives.

Anyone who has been prescribed a drug to take on an ongoing basis will remember a time they forgot to take their medication. Most probably, they didn’t give it a second thought and are even less likely to have realised that their non-adherence is part of a multibillion dollar problem facing the healthcare sector, one that results in hundreds of thousands of deaths every year.

According to a recent Vodafone white paper, entitled ‘The missing link in healthcare’, the lack of medical adherence leads to 125,000 deaths per year in the US alone, accounting for 69% of all medical- related hospital admittance and costing payers up to an estimated $290 billion each year.

For severe asthma, estimates suggest that the savings produced by optimal control would be around 45% of total medical costs, while improved medication adherence among patients with diabetes could result in over one million avoided emergency department visits and hospitalisations in the US annually.

The whys behind the problem are complex. In fact, there are over 700 identified reasons for non-adherence, ranging from concerns about side effects to bewilderment over complex treatment regimes. The only universal fact is that each individual patient is different, and therefore needs an individualised solution.

The good news is that a number of different factors are in the process of coming together to make a new approach to adherence – an internet of things (IoT)-enabled, and therefore much more personalised, one – not only possible but inevitable.

Data collection

IoT sensors are becoming smaller, more advanced and more affordable; connectivity is ubiquitous, fast and secure; cloud hosting is scalable and cost-effective; and the technology platforms that enable the development of novel solutions to measure patients’ adherence and engage them in improving it are ready to go. Not only that, but patients are ready, too – the likes of Fitbits and sleep-tracking apps have opened their eyes to the value of being in tune with their physical performance and health, and therefore better able to improve it.

Smart adherence solutions work on the same principle. Data is collected by tiny sensors in pill packets or medical devices to be analysed and then shared with patients via apps on their smartphones. The idea is that showing patients that they’re not following their treatment regime will provide a stronger impetus for them to do so.

By having a connected solution, we would be collecting pertinent data about that particular patient, making them feel like they have some ownership, and are empowered to be able to take control and begin to manage their own condition.

“To engage, patients need to feel that they are part of the process,” says Jon Lee-Davey, IoT health lead at Vodafone. “They also need to feel that the process is considerate of their own personal needs. By having a connected solution, we would be collecting pertinent data about that particular patient, making them feel like they have some ownership, and are empowered to be able to take control and begin to manage their own condition.”

For example, if a patient continued to miss their medication on Mondays and Wednesdays because of, for example, football practice, the technology could suggest they adapt their schedule to better suit their lifestyle. “It’s about having that feedback loop that allows it to be put in the context of the patient. That’s where it becomes that much more powerful,” Lee-Davey says.

The benefits of IoT-enabled adherence technologies would extend far beyond an improved patient experience. Armed with better data, doctors could make better decisions, while payers could make significant savings from a reduced need for stepped care.

“If patients aren’t taking their therapy, it might be that their disease progresses or their doctor recommends them to move into a third or fourth treatment, which could be more expensive,” explains Lee-Davey, who has been invited to speak to the European Parliament about the role the IoT could play in helping to share future European healthcare policy, evidence of just how seriously world leaders are taking this issue.

Plus, over time, an amount of data would be amassed that could be used to inform clinical research.

“One of the challenges of running clinical trials is that the data may be incomplete, and how do you test your hypothesis if you have an incomplete data set?” Lee-Davey asks. “Being able to gather accurate data during an expensive research process could lead to the development of better solutions and therapies.”

The missing link

According to Vodafone’s white paper, around half of patients being treated for long-term chronic illnesses such as hypertension, cancer or HIV do not stick to their recommended treatment programmes. Better approaches, those that connect the different technology dots in the treatment process, it claims, could bring 50% of the non-adherent population onside, potentially improving millions of lives and saving billions of dollars.

Personalisation is creeping into all aspects of modern healthcare – from tumour treatment and therapies for cystic fibrosis to voice assistants that can communicate with elderly patients in their own homes. Expanding this approach to medical adherence is the next logical step, and one Vodafone, as a technology and infrastructure provider, is working to help make a reality.

Already, the company, which connects 59 million ‘things’ via its Global Data Service Platform (GDSP) – more than any other company in the world – is helping to encourage adherence by providing connected solutions around sleep apnea and cardiac rhythm management devices.

Lee-Davey and his team see no reason why they cannot be the ones to bring together pharmaceutical and medical device companies, healthcare systems and technology companies to facilitate an industry-wide move towards individualised – and therefore much more effective – adherence solutions for drug regimens and other medical devices, too.

The excitement in Lee-Davey’s voice when he talks about a future in which his company is helping to change and inform the way people live by using connectivity to improve their health outcomes is palpable. He hopes the rest of the industry sees it the same way.

Delivering individualised healthcare: what do IoT-enabled adherence solutions mean for the future of healthcare?

More independence for patients

For patients, better adherence will mean better outcomes. They’ll be more likely to live longer. They’ll be less likely to suffer side effects from unnecessarily high doses. And with greater access to data on their own adherence and health, they’ll be in a better position to take charge of their own health and live more independent lives. As data analytics becomes more sophisticated, it’s possible that prescriptions could be changed automatically without the need for a clinical appointment.

More effective diagnosis and monitoring

But healthcare IoT technology doesn’t mean patients are left alone. It will give clinicians access to data that will help them make more effective diagnoses and prescribe the best possible treatments for individuals. That data won’t just be on adherence. They’ll also have access to real-time data from connected health monitoring devices as well as medical trials. With this, they’ll be able to aggregate data to develop stronger education programmes. And they’ll be able to correlate adherence data with research results to help, for example, tackle the issue of antimicrobial resistance. Artificial intelligence (AI), machine learning and advanced data analytics could provide valuable new insights.

Better drug development

In research and development, the healthcare IoT value chain will mean access to more accurate information when running clinical trials and developing drugs. With better adherence data, there will be a greater likelihood of a clinical trial completing successfully. And by using smart devices to manage the delivery of medication, they’ll be able to boost the success rate of their treatments.

Lower healthcare costs

For payers, better patient outcomes will mean lower costs. And the use of smart devices to improve adherence and measure health could prove a particularly attractive proposition for payers and health providers by helping avoid the need for stepped care.

Source: ‘The missing link in healthcare’, Vodafone

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